Kentucky Office of Community Health Worker (KOCHW) Inquiry Form
Please complete the brief form below for inquiries related to CHWs and the KOCHW. Please note that the KOCHW responds to inquiries in the order that they are received.
Name
*
First Name
Last Name
Email
*
example@example.com
Phone Number
*
Please enter a valid phone number.
What organization do you work for/ represent?
*
How can our office assist you?
*
CHW Certification Status
Update information in certification system
Applications (CHW Certification, CEU Application, or Approved Training Organizations)
Kentucky CHW Program Map (Updates, additions, questions, etc.)
CHW Trainings
CHW Certification Renewal
KOCHW Technical Support or Presentation
Information for KOCHW Connection
Other
Please elaborate
*
Submit
Should be Empty: